ABSTRACT This paper shows an investigation-intervention work of a systemic-constructionist approach based in the conversational-narrative, where the phenomenon of this study was made in a psychiatric hospital and a therapeutics community, were the narrative process (in the contextual help connection identified among institution-family-patient) and its association with the organization of psychoactive substance consumption as a problem and its influence in the maintenance, mobilization or transformation of such problem. It was seek to generate process comprehension where the actors co-participated in the history construction which it could allow or not the family development. In connection with the method, it is assumed a constructionist systemic perspective with a qualitative focus, design of conversational scenarios based on reflexive teams facilitators of the emergency of diverse voices and versions of the phenomenon, with two patients with problematic use of SPA, their families and professionals in each institution in charge of their treatment. As a result it emerge an important connection among the problem construction and the organization of relationships, identities and action paths of these actors.